Mixed Features in Bipolar Disorder

Definition of Mixed Features According to the DSM-V

Woman clutching her head in mental anguish
A woman suffering from mental anguish.. Peter Dazeley/Getty Images

A mixed episode is like what it sounds — a mixture of both depressive and manic symptoms. That being said, this phenomenon in bipolar disorder is a bit more complex than it sounds.

Let's review the diagnostic criteria of a mixed episode — now known as mixed features — according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Why is a Mixed Episode Now Called Mixed Features in Bipolar Disorder?

The DSM-V now refers to a mixed episode as mixed features.

This means that a person can be diagnosed with an episode of major depression, hypomania, or mania with "mixed-features." The reason for this change is that people rarely meet the criteria for having both a depressive and manic episode at the same time.

What Does Mixed Features Mean in Bipolar Disorder?

As the name implies, mixed features entails both symptoms of mania and depression. So if a person is said to be having mixed features, it means that they are either experiencing a manic episode with at least three symptoms of depression or a depressive episode with at least three symptoms of mania.

What is a Hypomanic or Manic Episode with Mixed Features in Bipolar Disorder?

A person may experience a manic or hypomanic episode with mixed features — meaning they meet the criteria for a hypomanic episode or manic episode and have three depressive symptoms like:

  • low mood
  • lack of interest or pleasure in activities once enjoyed
  • slowed down behavior
  • fatigue or loss of energy
  • thinking of death or suicide
  • feeling guilty
  • sleeping problems
  • problems concentrating

At least three of these symptoms must be present almost everyday during the most recent week of a manic episode or during the most recent four days of a hypomanic episode.

What is a Major Depressive Episode with Mixed Features in Bipolar Disorder?

A person may experience a depressive episode with mixed features — meaning they meet the criteria for a depressive episode, according to the DSM-V, but also have at least three symptoms of mania or hypomania.

These symptoms may include:

  • elevated, expanse mood or irritability
  • inflated sense of self
  • decreased need for sleep
  • increase in activity or energy
  • pressured speech
  • engaging in risk behaviors

At least three of these symptoms must be present almost everyday during the most recent two weeks of a depressive episode.

What Does This Mean for Me if I'm Bipolar?

Not much. This is more of a technical change in how psychiatrists diagnose and define your symptoms and episodes. If you are concerned that you are experiencing mixed features during a depressive, manic, or hypomanic episode, please be sure to contact your doctor, as this very well may affect your treatment regimen.

Sources:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

American Psychiatric Association. Help with Bipolar Disorders: What is a mixed episode? Retrieved November 1st 2015.

American Psychiatric Association. (2013). Mixed Features Specifier.

Hu J, Mansur R, & McIntyre RS. Mixed Specifier for Bipolar Mania and Depression:Highlights of DSM-5 Changes and Implications for Diagnosis and Treatment in Primary Care. Prim Care Companion CNS Disord. 2014;16(2): Pcc. 13r01599

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